The Diagnostics and Treatment of Acute Mediastinitis - Single Institute Experiences

Skala M1 , Sebek J1 , Vodicka J1 *, Safránek J1 , Geiger J1 , Zidkova A2 , Andrle P3 , Martínek J4 and Treska V

1 Department of Surgery, Charles University, Czech Republic 2 Department of Anesthesiology, Charles University, Czech Republic 3 Department of Stomatology, Charles University, Czech Republic 4 Department of Otorhinolaryngology, Charles University, University Hospital Pilsen, Czech Republic

^*Correspondance to: Vodicka J 

 PDF  Full Text DOI: 10.25107/2474-1647.3042

Abstract

Introduction: Acute mediastinitis is diffuse purulent inflammation which is spread in mediastinal connective tissue. It is caused by polymicrobial infection. Most frequently it originates by descendent spreading of odontogenic or peritonsillar infection or by contamination from perforated oesophagus. Materials and Methods: We treated 54 patients diagnosed with acute mediastinitis between 1.1.2007 and 31.12.2018. In this array were 36 men and 18 women. We followed ethiology and length of anamnesis, microbial specter, way of treatment and its results. Results: Descendent spreading from the neck was the cause of acute mediastinitis in 61% of patients. 32% of patients suffered from mediastinitis after perforation of the oesophagus. We did not clarify the origin of acute mediastinitis in 7% of patients. Length of anamnesis was between 0 and 14 days. Microbial specter was constituted from G+ bacteria in 57%, in 32% from G-respectively and the yeast-cells in 11%. Each patient underwent 3 surgical operations on average. Deep neck spaces drainage was performed in 18 cases, in 26 cases was performed collar mediastinotomy. Six patients underwent isolated chest drainage. We performed thoracotomy in 18 patients, thoracophrenolaparotomy in 5 patients. Inpatient treatment took 34 days on average. 15% of the patients died due to acute mediastinitis. Conclusion: Despite modern diagnostic methods and early surgical treatment is acute mediastinitis still a life-threatening disease. Early diagnosis of acute mediastinitis is necessary for successful treatment. Surgical treatment must be aggressive and extensive. The treatment is performed in cooperation of surgery and intensive care.

Keywords

Mediastinitis, Mediastinal infection, Descendent mediastinitis

Cite the article

Skala M, Sebek J, Vodicka J, Safránek J, Geiger J, Zidkova A, et al. The Diagnostics and Treatment of Acute Mediastinitis – Single Institute Experiences. Clin Surg. 2021; 6: 3042..